Transcript ADMINISTRATION OF OXYGEN

ADMINISTRATION OF
OXYGEN
SHARON HARVEY
LEARNING OUTCOMES
 THE STUDENT SHOULD BE ABLE TO:
 REVIEW THE PHYSIOLOGICAL
REQUIREMENTS OF THE BODY FOR
OXYGEN. IDENTIFY WHEN OXYGEN
THERAPY MAY BE NEEDED FOR AN ADULT
AND CHILD
 DEMONSTRATE HOW OXYGEN THERAPY
SHOULD BE PRESCRIBED USING A
PRESCRIPTION/MEDICATION CHART
LEARNING OUTCOMES
 DISCUSS THE SAFE AND EFFECTIVE
DELIVERY OF OXYGEN THERAPY WITH
PARTICULAR REFERENCE TO:
 USE OF COMMON DELIVERY APPARATUS
(FACEMASKS, NASAL CANNULA) FOR ADULT
AND CHILD
 SAFETY CONSIDERATIONS (THE CORRECT
FLOW RATE, AVOIDANCE OF NAKED FLAME)
 STORAGE AND DELIVERY OF OXYGEN IN
CLINICAL AREAS
LEARNING OUTCOMES
 DISCUSS THE PATIENT’S EXPERIENCE WHEN
UNDERGOING OXYGEN THERAPY
 IDENTIFY EFFECTIVE NURSING INTERVENTIONS TO
SUPPORT THE PATIENT, E.G. ORAL HYGIENCE,
ADEQUATE FLUID INTAKE, CORRECT POSITIONING
TO ACHIEVE MAXIMUM VENTILATION OF LUNGS
 DISCUSS THE INDICATIONS AND
CONTRAINDICATIONS FOR A CHILD AND ADULT:
 NASOPHARYNGEAL AND OROPHARYNGEAL SUCTIONING
 LOWER AIRWAY SUCTIONING
 SUCTIONING OF THE TRACHEOSTOMY
OXYGENATION
OXYGEN – A PRESCRIBED DRUG
 MUST BE WRITTEN LEGIBLY BY THE
DOCTOR
 PRESCRIPTION SHOULD BE DATED BY THE
DOCTOR
 DOCTOR MUST INDICATE DURATION OF O2
THERAPY
 THE O2 % CONCENTRATION MUST BE
PRESCRIBED
 THE FLOW RATE MUST BE PRESCRIBED
INDICATION FOR OXYGEN THERAPY
ACUTE RESPIRATORY FAILURE
ACUTE MYOCARDIAL INFARCTION
CARDIAC FAILURE
SHOCK
HYPERMETABOLIC STATE INDUCED BY
TRAUMA, BURNS OR SEPSIS
ANAEMIA
CYANIDE POISONING
DURING CPR
DURING ANAESTHESIA FOR SURGERY
OXYGEN DELIVERY SYSTEMS
BASIC COMPONENTS OF A OXYGEN
DELIVERY SYSTEM
PIPED OR
PORTABLE
CYLINDER
OXYGEN SUPPLY
A REDUCTION
GAUGE
FLOW METER
(LITRES/MIN)
BASIC COMPONENTS OF A OXYGEN
DELIVERY SYSTEM
 DISPOSABLE
TUBING OF
VARYING DIAMETER
AND WIDTH
 MECHANISM FOR
DELIVERY (MASK
OR CANNULA)
 HUMIDIFIER (TO
WARM AND
MOISTEN THE O2
METHODS OF ADMINISTERING
OXYGEN
 SIMPLE SEMI-RIGID MASKS
 NASAL CANNULA
 FIXED PERFORMACE MASKS OR HIGH-FLOW
MASKS (VENTURI)
 T-PIECE CIRCUIT
 PAEDIATRIC CIRCUITS - HEADBOX OR HOOD
- O2 TENT/COT
 TRACHEOSTOMY MASK
 MECHANICAL VENTILATION
 CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)
HUMIDIFICATION OF OXYGEN
 NORMAL AIR TRAVELLING THROUGH THE
AIRWAYS IS WARMED, MOISTENED AND FILTERED
BY EPITHELIAL CELLS OF THE NASOPHARYNX
 THE AIR ENTERING THE TRACHEA WILL HAVE A
RELATIVE HUMITY OF 90% AND A TEMPERATURE
OF BETWEEN 32-36 C
 OXYGENATION WILL CAUSE DEHYDRATION OF THE
MUCUS MEMBRANES AND PULMONARY
SECRETIONS
 HUMIDITY IS ESSENTIAL FOR PATIENTS WHO
HAVE AN ENDOTRACHEAL OR TRACHEOSTOMY
TUBE
HUMIDIFICATION REQUIREMENTS
 HUMIDIFICATION AND TEMPERATURE
SHOULD NOT BE AFFECTED BY THE FLOW
RATE
 SAFETY ALARMS SHOULD GUARD AGAINST
OVERHEATING, OVER HYDRATION AND
ELECTRIC SHOCK
 NO INCREASED RESISTENCE TO
RESPIRATION
 WIDE BORE TUBING (ELEPHANT) SHOULD
BE USED TO ALLOW SUFFICIENT
FORMATION OF WATER VAPOUR
HEALTH AND SAFETY ISSUES WITH
O2
 MEDICAL GAS
CYLINDERS HAVE
TO CONFORM TO
COLOUR CODING
 CURRENTLY
OXYGEN
CYLINDERS ARE
BLACK WITH WHITE
SHOULDERS.
HEALTH AND SAFETY ISSUES WITH
OXYGEN
 OXYGEN IS
COMBUSTIBLE
 OIL AND GREASE
AROUND
CONNECTIONS
SHOULD BE AVOIDED
 ALCOHOL, ETHER AND
INFLAMMATORY
LIQUIDS SHOULD BE
KEPT SEPARATE FROM
O2
 NO ELECTRICAL DEVICES
NEAR 02 TENT
 NO SMOKING
 FIRE EXTINGUISHER NEEDS
TO BE AVAILABLE
 CARE WITH USING
DEFIBRILLATOR NEAR HIGH
OXYGEN
CONCENTRATIONS
POTENTIAL PROBLEMS
 CO2 NARCOSIS
 CO2 LEVELS IN THE BLOOD NORMALLY INFLUENCES
RESPIRATION
 PATIENTS WHO ARE HYPERCAPNIC CO2
E.G. CHRONIC BRONCHITIS, HAVE THEIR BRAIN
CHEMORECEPTORS NO LONGER SENSITIVE TO
LEVELS
CO2
- INSTEAD THE HYPOXIC DRIVE BECOMES THE
RESPIRATORY DRIVE I.E. O2 IS THE DRIVE FOR
RESPIRATION
- HIGH LEVELS OF SUPPLEMENTARY O2 MAY LEAD TO
REPIRATORY DEPRESSION/UNCONSCIOUSNESS AND
DEATH
POTENTIAL PROBLEMS
 OXYGEN TOXICITY
THIS FOLLOWS AFTER PROLONGED O2 THERAPY
(>24 HOURS)
THERE IS DECREASING LUNG COMPLIANCE FROM
HAEMORRHAGIC INTERSITIAL AND INTRAALVEOLAR OEDEMA
THIS ULTIMATELY LEADS TO FIBROSIS OF LUNG
TISSUE
>24 HOURS AND > 50 % O2 THERAPY SHOULD BE
AVOIDED
PRINCIPLES OF
SUCTIONING
SHARON HARVEY
PRINCIPLES OF SUCTIONING
THREE PRIMARY SUCTIONING
TECHNIQUES ARE:
OROPHARANGEAL/
NASOPHARANGEAL SUCTIONING
OROTRACHEAL AND NASOTRACHEAL
SUCTIONING
SUCTIONING AN ARTIFICAL AIRWAY
SIGNS OF A NEED FOR
SUCTIONING
 RESPIRATORY RATE
 CHANGE IN
RESPIRATORY
PATTERN
 NOISY BREATHING
 DIFFICULTY
SUCTIONING
 REDUCED OR UNEVEN
AIR ENTRY
 INCREASED AIRWAY
PRESSURE
 SURGICAL
EMPHYSEMA OR
OTHER NECK
SWELLING
 DISTRESSED
PATIENT
 HYPOXIA
 THE ABILITY TO
HEAR THE PATIENT
SPEAK WHEN CUFF
IS INFLATED
PRINCIPLES OF SUCTIONING
 OROPHARYNGEAL SUCTIONING REMOVES
SECRETIONS FROM THE PHARYNX VIA A
CATHETER PLACED THROUGH THE MOUTH
OR NOSTRILS
 THIS TYPE OF SUCTIONING IS USED WHEN
THE PATIENT S ABLE TO COUGH
EFFECTIVELY BUT UNABLE TO CLEAR
SECRETIONS BY EXPECTORATING OR
SWALLOWING
 PROCEDURE IS CARRIED OUT AFTER THE
PATIENT HAS COUGHED
ASSESSMENT PRIOR TO
SUCTIONING
ABNORMAL BREATHING SOUNDS
IRREGULAR RESPIRATORY PATTERN
CHANGES IN SECRETIONS
INCREASE IN COUGHING INCIDENTS
CHANGE IN PATIENT’S APPEARANCE
COMPLICATIONS OF SUCTIONING
TRAUMA
HYPOXIA
INFECTION
OROPHARYNGEAL SUCTIONING
 MEASUREMENTS?
ALWAYS USE THE SMALLEST DIAMETER SUCTION
CATHETER POSSIBLE TO REMOVE THE
SECRETIONS
FOR ADULTS USE CATHETERS SIZE 12-16 FRENCH
GAUGE
FOR CHILDREN USE 8-12 CATHETER GAUGE
 INSERTION DEPTH
FOR NASOPHARYNGEAL SUCTIONING:
ADULTS INSERT ABOUT 16CM
INFANTS AND YOUNG CHILDREN 4-8 CM
OROPHARYNGEAL SUCTIONING
CAUTION ON PATIENTS WITH:
NASOPHARYNGEAL BLEED OR CSF LEAK
ANTI COAGULANT THERAPY
OROPHARYNGEAL SUCTIONING
PROCEDURE
 REVIEW OXYGEN SATURATIONS AND BREATHING
PATTERN
 EVALUATE ABILITY TO COUGH
 CHECK HISTORY FOR DEVIATED SEPTUM, NASAL
POLYPS, NASAL OBSTRUCTION, TRAUMATIC
INJURY, EPISTAXIS OR MUCOSAL SWELLING
 EXPLAIN PROCEDURE
 INFORM THAT SUCTIONING MAY CAUSE TRANSIENT
COUGHING AND GAGGING
 MINIMISE ANXIETY
 POSITION PATIENT IN AN UPRIGHT POSITION TO
PROMOTE LUNG EXPANSION
OROPHARYNGEAL SUCTIONING
TURN ON SUCTION (80-120 MMHG)
EXCESSIVE PRESSRE MAY CAUSE
TRAUMA
OCCLUDE THE END OF CONNECTING
TUBE TO CHECK SUCTION PRESSURE
ASEPTIC TECHNIQUE
USE LUBRICANT IF THE CATHETER IS
PASSED THROUGH NASAL PASSAGE
OROPHARYNGEAL SUCTION
 USE YOUR DOMINANT HAND TO CONTROL
THE CATHETER
 USE YOUR OTHER HAND TO CONTROL
SUCTION VALVE
 PATIENT TO COUGH AND BREATH DEEPLY
BEFORE SUCTIONING
 COUGHING HELPS TO LOOSEN
SECRETIONS
 DEEP BREATHING HELPS TO MINIMISE
HYPOXIA AND LUNG COLLAPSE
OROPHARYNGEAL SUCTIONING
SPECIAL CONSIDERATIONS
ALTERNATE BETWEEN NASAL PASSAGES
TO MINIMISE TRAUMATIC IJURY
WHERE REPEATED SUCTIONING IS
REQUIRED, A PHARYNGEAL AIRWAY WILL
HELP WITH CATHETER INSERTION,
REDUCE TRAUMA AND PROMOTE PATENT
AIRWAY
RESPT PATIENT AFTER SUCTIONING AND
OBSERVE
OROPHARYNGEAL SUCTIONING
COMPLICATIONS
DYSNOEA
BLOODY ASPIRATE
DOCUMENTATION
RECORD THE DATE
TIME
PROCEDURE
TECHNIQUE
REASON FOR SUCTIONING